Funding of primary care services

22.11.01

2 Deputy G.P. Southern of the Minister for Health and Social Services regarding

funding of primary care services (OQ.104/2022):

Will the Minister outline any plans under consideration for the funding of primary care services; advise what, if any, discussions on funding have occurred between the Ministers responsible for the services and representatives of G.P.s (general practitioners) and pharmacists; whether a survey of public opinion around such funding is currently being conducted, if that the survey conforms to the highest standards of objectivity and when the results will be published?

Deputy K. Wilson of St. Clement (The Minister for Health and Social Services):

Thank you to the Deputy for his question. As set out in my answer to Written Question 174, the Government Plan commits Minister for the Environment to bringing froward options for new healthcare funding system with a view to any new system being operational by 2025. I can confirm to the Assembly that this work has started. We are going to contract specialists in health economics to support us to estimate the future total of healthcare expenditure in Jersey, including out-of- pocket expenditure incurred by Islanders and to support us to examine future funding options. This could include funding via taxation, compulsory insurance, user pays, or any combination of these routes. In determining these options we will consider fairness and how to incentivise the use of preventative services. We will be consulting Ministers and all providers in early 2023. We are also conducting a survey to help us better understand the public’s attitude to health funding. The survey is due to be distributed in late October but is slightly delayed as we have had some additional advice from the chief statistician on the design of the questions to ensure objectivity. As already committed, I will ensure the Deputy and his Scrutiny Panel are sent a copy of the survey before it is distributed. It is anticipated that the results of the survey will be available in January 2023 and these results will help inform consultation with the providers.

1. Deputy G.P. Southern :

The question arises then what negotiations or what consultations are going on currently today? Not in 2 years’ time when you have come to some sort of conclusion about what is the way forward, but now when G.P.s and pharmacists do not understand what is likely to happen next, have been insulted by the sums involved; the £20.28 that has been in place for 10 years and reflects how low we consider the G.P.s to be. Will the Minister state what progress she is making and what conversations she will have or has had with G.P.s and pharmacists delivering the primary care system, which so far appears to have been stymied?

Deputy K. Wilson :

What I can assure the Deputy is that I have met with members of the primary care body and I have also met with members of the pharmaceutical body. We also have a piece of work ongoing around the primary care strategy, which involves these key stakeholders. What I will be able to do is bring back to the Assembly the outputs of that. But what I can assure Deputy is that there are conversations ongoing. I just want to pick up the point about who we speak with and I think the important thing here is that we have to engage the public in understanding their attitudes to a health funding model before we can go and talk to the people who will be the recipients of that. That is the position, that we are taking on this issue.

2. Deputy S.Y. Mézec of St. Helier South:

Does the Minister recall a previous survey that looked into public views on the funding of primary care which showed at the time that there was majority support from patients for maintaining a fee to see the G.P., which was used as justification at the time for maintaining a fee, but when you scratched beneath the surface you discovered that those who supported maintaining it were those who could afford it, and those who opposed it, with those who could not afford it. Therefore the presentation of that survey result led to flawed conclusions. Will she guarantee us that such a survey this time round will not do so?

Deputy K. Wilson :

Thank you to the Deputy for his question again. What I would like to assure the Assembly is that this is a new Government, a new Council of Ministers, with a new and refreshed approach to the way we do things. The first piece of engagement work, as I alluded to in my Written Question earlier this year, was that we do want to support a better understanding of the implications of the costing and funding models for healthcare going forward. As I have said before, the objectivity that we need in the survey results hopefully will address some of those issues and anomalies that the Deputy has highlighted in order for us to get the right information.

3. Deputy S.Y. Mézec :

It may be a new Government but it is one whose Ministers are seldom able to give us any clarity about what is tangibly going to happen to any of these policies and instead simply says they are reviewing, reviewing and reviewing everything. Will the Minister attempt now to give us some clarity on what she believes is the direction of travel that ought to be pursued to make primary care more accessible for those who need it?

Deputy K. Wilson :

What I will not be forced into or rushed into is making any snap decisions about how we do things. As the Deputy will appreciate with, I think it is 107 days in, we need to understand the evidence base for how these things are, but I appreciate there is evidence there that is really important to incorporate as part of the review. I can absolutely assure him that action will be delivered on this very quickly.

4. Deputy R.J. Ward :

Will the Minister commit to ensuring that any public consultation is inclusive of all of our communities? By that I mean not just different languages but different abilities, those who are perhaps with learning disabilities, those who are at the bottom of the income scale, who absolutely do not engage in these surveys.

Deputy K. Wilson :

We are hoping to circulate about 3,500 survey questionnaires across the Island. But what I will guarantee is that we will make sure that those surveys will be representative of all of our communities. They will be written and communicated in a way that is inclusive and able to capture the views of all people with all needs across the Island.

5. Deputy R.J. Ward :

I ask the Minister to be aware that literacy issues are not just those that are linked to the English language but they are linked to all languages that are spoken and used on this Island. Just sending a leaflet in another language is often not enough to engage people in a consultation.

Deputy K. Wilson :

We will be putting a communications framework around this, I can assure the Deputy . We will make sure that we reach out to every single citizen, as far as we possibly can. Clearly it will be people’s choice to engage with us, with the method by which we involve and support participation will be very different to what he has experienced previously.

6. Deputy C.S. Alves of St. Helier Central :

Is the Minister able to inform the Assembly how much is spent on primary healthcare and how this compares to other O.E. C.D . (Organisation for Economic Co-operation and Development) countries?

Deputy K. Wilson :

The detail around this does not rest with my portfolio but I would be happy to work with my colleague, the Minister for Social Security, to bring forward that detail.

7. Deputy C.S. Alves :

Will the Minister come back to the Assembly with that information then, please?

Deputy K. Wilson :

Yes, I can confirm I will.

8. Deputy L.V. Feltham :

In her initial answer the Minister referred to potential for compulsory insurance as being one of the potential funding mechanisms. Does that mean that the Government is currently looking at privatising other areas of the health service that are currently being run by government?

Deputy K. Wilson :

I think the Deputy raises a very interesting question but what I can assure you is that our focus around sustainable healthcare funding relates purely and solely to the way in which we currently fund our health system. We need to be able to look at all options to make sure that this funding mechanism is sustainable. The details of which I clearly want to bring back to the Assembly in due course.

9. Deputy P.M. Bailhache :

Is the Minister aware that officials conducting this review have not responded to requests from the primary care body for a meeting and will she encourage those officials to do so?

Deputy K. Wilson :

Thank you to the Deputy for the question. I was not aware but I do know that there were and are a number of meetings held with primary care colleagues, and have been present at some of those myself. But I will take the question that the Deputy has raised and seek further information on that and address that directly.

[10:00]

10. Deputy G.P. Southern :

Can the Minister confirm that she has had no more than one meeting with G.P.s and will she give a date - that is not a quick reaction but a considered reaction - by which she will come back to the House and state how primary care will be continued from now onwards in the short term and the medium term, not necessarily in the long term.

Deputy K. Wilson :

What I want to outline is that this is the first phase of a piece of work to develop the proposals going forward. The second phase will take place in quarter 3 of 2023. What I am proposing to do is to bring updates along the way to the Assembly to let them know where we are in relation to the development of these proposals so that the Assembly is kept informed fully of the progress that we are making.